Malignant pleural mesothelioma presenting with symptomatic brain metastases: report of a case

Vol. 54 No. 3 Suppl., 2013
This supplement was not sponsored by Outside Organizations.


A. Marzullo, Anna Scattone, Roberta Rossi, Antonietta Cimmino, Alessandra Punzi, F. Corsi, Domenica Cavone, Teresa Lettini, Gabriella Serio

We describe a unique case of brain metastases presenting as first symptom of a malignant mesothelioma (MM). MM is a highly aggressive tumor of the serous membrane that is generally believed to be rarely metastasizing. Recently, the reports of long surviving cases and larger literature reviews have suggested that cerebral metastases are not so uncommon. An extensive histochemical and immunohistochemical panel is needed to achieve a correct differential diagnosis, especially in the epithelioid type. Pathologists should be aware that brain metastases could have a mesothelial origin.

Corresponding author: Gabriella Serio, MD, PhD; e-mail:

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Ionela Teodora Dascalu, Mihaela Jana Tuculina, Mihaela Raescu, Sanda Mihaela Popescu, Claudia Corega, Ligia Vaida, Adriana Bold

Angle Class III malocclusions are not so frequently met but they raise big problems of treatment. The analyzed case represents a 14-year-old patient that came to the dental consulting room with an Angle Class III malocclusion determined by the excess of the somatotropic pituitary hormone and a gingival hyperplasia more emphasized at the level of inferior frontal teeth. The patient followed a fixed appliance treatment, the straight-wire technique. All along the treatment and after it, the hyperplasia and the gingival inflammation not only maintained but they even got worse. Thus, an improper hygiene associated with a severe Angle Class III malocclusion maintains and aggravates the gingivitis. The histological and immunohistochemical study of the gingiva revealed important epithelial modifications that led to an epithelial hypertrophy with a tendency toward acanthosis and to severe epithelial erosions. An inflammatory chronic process (rich in lymphocytes, plasma cells and macrophages full of angiogenesis vessels) and an intense reaction of the fibroblastic cells appeared in the gingival corium.

Corresponding author: Adriana Bold, Associate Professor, MD, PhD; e-mail:

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